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At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[The nerves of the paravasal fatty tissue of the human iliac vessels].

The aim of the work was to concretize ideas of the anatomy of extraintramural nerve plexuses along the course of large iliac vessels. Three nerves with the diameter 0.6-2 mm were revealed running from the iliac plexus to the paravasal fat. Topographic anatomical characteristics of these formations and their interrelations with the well-known branches of the lumbar plexus are given with special reference to practical value of the results obtained. The relation of nerves of the paravasal fat to adventitia of the vessels, lymph nodes, fascial and muscular formations was studied.

Adipose Tissue↗
PubMed2001

Nerve-preserving aortoiliac reconstruction surgery: anatomical study and surgical approach.

OBJECTIVE: Dysfunctional ejaculation and, to a lesser extent, dysfunctional erection caused by disruption of efferent sympathetic pathways is a common complication after aortoiliac reconstruction surgery. The aim was to give an anatomic motivation for a nerve-preserving approach on the basis of right-sided unilateral disruption of lumbar splanchnic nerves. METHODS: Anatomic and microscopic analysis of preaortic and para-aortic retroperitoneal regions in human cadavers was performed. Anatomic analysis was conducted of two aortoiliac reconstruction operations performed on human cadavers; one was performed according to a single-blind procedure, the second with a modified procedure. RESULTS: The lumbar splanchnic nerves supplying the superior hypogastric plexus from the right side were found to be less voluminous than the left-sided ones. The superior hypogastric plexus was found slightly shifted to the left of the midsagittal plane across the abdominal aorta and its bifurcation. Microscopic analysis revealed a thin fascia between the aorta and the subperitoneal tissue compartment. This fascia was used as a plain of dissection to mobilize the preaortic nerve-plexuses without damage from the aortic wall. Analysis of the specimens operated on showed a significant difference in nerve disruption. The standard procedure caused total disruption of the superior hypogastric plexus and extensive disruption of the inferior mesenteric plexus. The modified procedure only caused right-sided unilateral disruption of lumbar splanchnic nerves. CONCLUSION: The autonomic nerves supplying the bladder neck, the vas deferens, and the prostate are closely related to the abdominal aorta and its bifurcation. Right-sided unilateral disruption of lumbar splanchnic nerves without further damage to nervous structures would ensure at least one functional sympathetic pathway remaining after aortoiliac reconstruction surgery.

Aorta, Abdominal↗
PubMed1998

[Substantiation of the use of implantation method in surgical reinnervation of kidney transplant].

New operative method of surgical reinnervation of transplanted kidney was elaborated, experimentally substantiated on 39 mongrel dogs and used in 26 recipients of allonephrotransplants in three transplantation centres. The efficacy and security for recipient of the proposed combined implantation in sinus of transplanted kidney of atraumatically mobilized iliac vegetative plexuses consisting of fascia-adventitia strip-like flaps and lower hypogastric nerves of recipient zone with the neuroterminals preserved was noted. The method may be used independently and in combination with method of nephrogangliotransplantation.

Animals↗
PubMed1985

[Aortic surgery and sexual function].

An account is offered of the haemodynamic and neurological questions posed by the relation between reconstructive aortoiliac surgery and sexual function. Attention is drawn to the anatomical and surgical features of the preaortic sympathetic structures. In the light of experience gained in pelvic haemodynamic evaluation with the Doppler penile pressure index, a method that has proved very useful in the study of pre- and postoperative impotence in the arteriopathic subject, stress is laid on three conclusions: a) the high frequency of impotence in aortoiliac arteriopathy (65% in a personal series); b) the beneficial effect on penile circulation of revascularisation of the hypogastric artery (increase in pressure index in 70% of cases); c) the relatively high incidence of postoperative sexual disturbances (30% in the personal series) due to lesion of the preaortic sympathetic structures, the risk being greater with techniques requiring wide exposure of the aorta. This danger is foreseeable in all sexually potent patients and should determine the indication for surgery, the method chosen (extra-peritoneal route, extra-anatomical by-pass), and the technique (in an aorto-femoral by-pass, the aorta should be prepared in accordance with carefully followed rules of surgical anatomy, and confined wherever possible to a short infrarenal segment).

Aorta, Abdominal↗
PubMed1980

The embryonic development of the main lymphatics in man.

A study of microscopical serial sections of 40 well-preserved human embryos, ranging in age from about 40 to 65 days (8-33 mm C.-R. length), revealed that the prevertebral main lymphatics develop from a number of separate primordia, all derived from venous walls. These primordia are: paired jugular and axillary lymph sacs and paratracheal, internal throacic, lumbar and iliac lymph plexuses, and single subtracheal and mesenteric lymph plexuses. Probably, the thoracic ducts develop from a series of small additional primordia. All these primordia, except the jugulo-axillary lymph sacs, lose their connections with the veins. They rapidly enlarge, fuse with one another and send out sprouts into peripheral regions, so that soon the definitive pattern of the major lymphatics can be recognized. During development some variations may occur, in particular in the area where the lower extensions of the two throacic ducts meet the lumbar lymph plexuses. Usually, the right thoracic duct primarily comes into contact with the jugulo-axillary lymph sac. The conclusion is drawn that on an embryological basis in the prevertebral region additional lymphatico-venous communications might be expected, but that possible lymphatico-venous communications elsewhere in the body always point to developmental aberrations or to pathology.

Axilla↗
PubMedDate not supplied

[Compression of the lumbosacral plexus in a case of voluminous aneurysm of the common iliac artery].

The clinical case presented is one of common iliac artery aneurysm, provoking a radicular compression symptomatology from L4 to S1. It is stressed that neurologic disorders having a radicular content are extremely rare in aorta-iliac vascular compressive pathology. In the case described, the involvement of several nerve roots is attributed to the aneurysm's unusual size (like a fetus' head) of the aneurysmatic sac.

Aged↗
PubMed1985

Autoradiographic localization of binding sites for atrial natriuretic factor.

The distribution of atrial natriuretic factor (ANF) binding sites in Wistar rat tissues, as well as tissues from other species was studied. Using autoradiography of slide mounted tissue sections incubated with 125I-labelled ANF, high densities of binding sites were found in the renal glomeruli and papilla, aortic smooth muscle, iliac vein, choroid plexus, anterior pituitary, lung, and adrenal zona glomerulosa. Results from renal, aortic, adrenal, and lung tissues from spontaneously hypertensive rats did not differ from those of Wistar rats. Binding sites were also observed in guinea pig glomeruli, renal medulla, and aorta as well as in the rabbit aorta.

Adrenal Cortex↗
PubMed1984

[Sexual function after vascular surgical interventions in the aortoiliac area--causes and the avoidance of impotence].

Neurogenic and vasculogenic impotence after aortoiliac reconstruction is an unpleasant problem in vascular surgery. The importance of maintaining or restoring intraoperatively a sufficient hypogastric artery blood flow is emphasized. Postoperative neurogenic sexual disabilities are irreversible and are due to interruption of sympathetic nerve fibers supplying the genital system. Dissecting the terminal aorta and the iliac arteries the hypogastric sympathetic plexus--which descends across the bifurcation--can be easily damaged. This is the cause of the high incidence of failure of ejaculation after aortoiliac surgery. In order to avoid this neurogenic sexual dysfunction a retromesenteric approach to the aortoiliac region is anatomically suggested by A. v. Hochstetter. It enables the exposure of the abdominal aorta and the iliac arteries without disrupting the superior hypogastric plexus and its variants. Respecting the integrity of the sympathetic plexus and a sufficient flow in the internal iliac artery the frequency of postoperative disturbances of erection was reduced from 17% (1199 patients) to 12.3% (570 patients). The incidence of postoperative loss of ejaculation in the same groups of patients decreased from 81% to 20%.

Aorta, Abdominal↗
PubMed1999

Complications during anterior surgery of the lumbar spine: an anatomically based study and review.

Procedures involving anterior surgical decompression and fusion are being performed with increasing frequency for the treatment of a variety of pathological processes of the spine including trauma, deformity, infection, degenerative disease, failed-back syndrome, discogenic pain, metastases, and primary spinal neoplasms. Because these operations involve anatomy that is often unfamiliar to many neurological and orthopedic surgeons, a significant proportion of the associated complications are not related to the actual decompressive or fusion procedure but instead to the actual exposure itself. To understand the nature of these injuries, a detailed anatomical study and dissection was undertaken in six cadaveric specimens. Critical structures at risk in the abdomen and retroperitoneum were identified, and their anatomical relationships were categorized and photographed. These structures included the psoas muscle, kidneys, ureters, diaphragm and crura, esophageal hiatus, thoracic duct, greater splanchnic nerves, phrenic nerves, sympathetic chains, medial arcuate ligament, superior and inferior hypogastric plexus, segmental and radicular vertebral vessels, aorta, vena cava, median sacral artery, common iliac vessels, iliolumbar veins, lumbosacral plexus, and presacral hypogastric plexus. Based on these dissections and an extensive review of the literature, the authors provide a detailed anatomically based discussion of the complications associated with anterior lumbar surgery.

Journal Article↗
PubMed1978

[Phlebography of the testicular veins for varicoceles and their recurrences (author's transl)].

The clinical significance of varicoceles depends on their frequency and on the fact that they may produce infertility. The available operative forms of treatment are unsuccessful in about 10% of patinents. In these cases it is desirable to elucidate the very variable drainage pattern by means of transfemoral phlebography with the patient erect. The method was employed in 13 patients and demonstrated continuity of the testicular vein, or of one of its tributaries, in twelve. If the testicular vein appears to be absent, one must consider the possibility of a venous short circuit or drainage of the pampiniform plexus into the external iliac vein. In four patients out of the 13, scrotal phlebography in addition for complete definition was necessary.

Adolescent↗
PubMedDate not supplied

[Anatomo-clinical correlations in pulmonary thromboembolism (observations on 258 cases)].

The authors studied 258 cases of deaths due to lung thromboembolization, totalling 13% of the necropsies. The patients' age ranged within 17-89 years, with the highest frequency between 70 and 75 years. The female sex was prevalent (56% of cases). According to the magnitude of the vessel occluded, the thromboembolisms were divided into: massive (35%), medium (50%) and small (15%). The lung infarctions were present in 42% of the cases investigated. The formation site of the thrombi was exactly established in 24% of the cases; the right side of the heart, the lung, the deep veins of the shank, periprostatic venous plexus, vena cava inferior, iliac veins. The lung thromboembolization was favoured by the cardiovascular affections (38.5%), neurologic affections (27%), malignant tumours (11.5%), postsurgery status (9%), lung diseases (9%), coma (3.5%), prostate affections (1.5%). The clinical diagnosis was established in 22% of cases. In the rest of them, thromboembolization was hidden or simulated by the coexisting affection.

Adolescent↗
PubMed2002

Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation.

UNLABELLED: A computed tomographic scan was obtained in 35 patients to measure the depth and the relationship of the branches of the lumbar plexus to the posterior superior iliac spine projection and the vertebral column. In addition, we prospectively studied 80 patients scheduled for total hip arthroplasty who received a continuous psoas compartment block (CPCB) in the postoperative period. CPCB was performed after surgical procedures by using modified Winnie's landmarks and nerve stimulation. From 5 to 8 cm of catheter was inserted. Radiographs were obtained after injection of 10 mL of contrast medium. An initial loading dose (0.4 mL/kg) of 0.2% ropivacaine was injected, followed by continuous infusion of 0.2% ropivacaine for 48 h. The depth of the lumbar plexus and the distance between the lumbar plexus and the L4 transverse process were measured. Visual analog scale values of pain at 1, 12, 24, and 48 h were obtained at rest and during mobilization. Amounts of rescue analgesia were also recorded. Sensory blockade of the principal branches of the lumbosacral plexus was noted at 1 and 24 h, as were adverse events related to the technique. There was a significant difference between men and women in depth of the lumbar plexus (median values, 85 vs 70 mm for men and women, respectively). There was a positive correlation between the body mass index and skin-lumbar plexus distances. In contrast, there was no difference regarding the distance between the transverse process of L4 and the lumbar plexus. The catheter tip lay within the psoas major muscle in 74% of the patients and between the psoas and quadratus lumborum muscles in 22%. In three patients, the catheter was improperly positioned. At 1 h, sensory blockade of the femoral, obturator, and lateral femoral cutaneous nerves was successful in, respectively, 95%, 90%, and 85% of patients. At 24 h, these rates were 88%, 88%, and 83%, respectively. During the 48-h study period, median visual analog scale values of pain were approximately 10 mm at rest and from 18 to 25 mm during physiotherapy. Five patients received 5 mg of morphine at 1 h. Five cases of unilateral epidural anesthesia were noted after the bolus injection. We conclude that CPCB with 0.2% ropivacaine allows optimal analgesia after hip arthroplasty, with few side effects and a small failure rate. Before lumbar plexus branch stimulation and catheter insertion, anesthesiologists should be aware of the L4 transverse process location and lumbar plexus depth. IMPLICATIONS: Lumbar plexus depth is correlated with the patient's body mass index and differs between men and women, but this is not true of the lumbar plexus-transverse process distance. Considering new landmarks, a continuous psoas compartment block promotes optimal analgesia after hip arthroplasty, with few side effects.

Adult↗
PubMed1999

Examination of nodal metastases by a clearing method supports pelvic plexus preservation in rectal cancer surgery.

PURPOSE: In rectal cancer surgery preservation of urinary and sexual function is attempted by means of operations preserving the autonomic nerves of the pelvic plexus. Emergence of residual cancer because of a more shallow plane of dissection is a problem of concern with these methods, so we examined indications for pelvic plexus preservation. METHODS: We studied 198 patients with rectal carcinoma who underwent abdominopelvic lymphadenectomy. Lymph nodes along the superior hemorrhoidal artery and middle hemorrhoidal artery medial to the pelvic plexus were defined as perirectal nodes, and nodes along the middle hemorrhoidal artery lateral to the pelvic plexus and along the internal iliac artery represented lateral intermediate nodes. Node metastases were examined by the clearing method. RESULTS: Metastasis to perirectal nodes occurred in 12.5 percent in patients with pT1 tumors, 28.9 percent of those with pT2 tumors, and 50.0 percent of those with rectosigmoid junctional cancer. Metastasis to lateral intermediate nodes was absent in patients with pT1 or pT2 tumors and was as low as 2.5 percent in patients with rectosigmoid junctional cancer. CONCLUSIONS: In patients with T1, T2, and rectosigmoid junctional cancer, perirectal node dissection is necessary, but chances of residual cancer should remain minimal when the pelvic plexus is preserved.

Humans↗